Fungal Sinusitis: Current Trends in Diagnosis and Treatment

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Mycetoma (Fungus Ball)

Mycetoma, more properly called fungus ball, expands within the confines of an immunocompetent, nonatopic host sinus and does not invade or penetrate the sinus mucosa. Aspergillus is the primary causative organism. It usually involves a single sinus, most often the maxillary sinus.[19] Presentation is typically an incidental finding on the CT scan of the head or sinuses or dental x-rays, which shows opacification with areas of hyperdensity without erosion of the sinus walls. Some patients have no symptoms; others complain of rhinorrhea, nasal obstruction, and/or facial fullness. Treatment consists of complete removal of the fungus ball via currettage with adequate ventilation. Recurrences are rare. Morpeth and colleagues[20] determined that mycetoma accounts for approximately 10% of chronic noninvasive fungal sinusitis.

A 70-year-old white male presented to the neurology clinic with headache. The workup included a CT scan of the head that was suspicious for a lesion in the maxillary sinus. A formal CT scan of the sinuses was obtained (Figures 4 and 5). The patient underwent functional endoscopic sinus surgery (FESS) and debridement. Pathology revealed Aspergillus without any bony invasion.

Figure 4.

Axial head CT scan revealing a mass filling left maxillary sinus without bony erosion. Hyperdensities that appear the same density as bone are seen within the central portion of the maxillary sinus.

Figure 5.

Axial CT scan of the sinuses with opacification of the left maxillary sinus. Note the hyperdensities within the sinus

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